Limited Power Of Attorney (Unclaimed Funds)

UNITED STATES BANKRUPTCY COURT FOR THE SOUTHERN DISTRICT OF IOWA 110 E. Court Avenue, Ste 300 Des Moines, Iowa 50309 www.iasb.uscourts.gov In the Matter of: Case No. LIMITED POWER OF ATTORNEY To: (name address of agent/attorney-in-fact) The undersigned claimant hereby authorizes you to act as attorney-in-fact for the undersigned only to collect uncollected, undistributed, or unclaimed funds held by the court and owing to _________________________________________(name of claimant) in the amount of $______________. Dated: Signature: Name: Address: Telephone: Social Security Number: XXX-XXAcknowledged before me on the ________ day of __________________, 20_____, by _________________________________, who says that he/she is the person name above and is authorized to execute this power of attorney. Signature_________________________________ Notary Public J:\Web\Forms\PDF Files\POA Unclaimed Funds.pdf 7/19/13 American LegalNet, Inc. www.FormsWorkFlow.com